Humana is accelerating its efforts to reform the prior authorization process through a series of new policies, following the broader insurance industry’s recent pledge to reduce and streamline prior auth requirements.
By January 1, 2026, Humana will eliminate one-third of prior authorization requirements for outpatient services, including for diagnostic services across colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs.
Under the same timeline, the company is committing to providing decisions within one business day on at least 95% of all complete electronic prior authorization requests. Currently, a decision is provided within one business day on more than 85% of outpatient procedures.
Also in 2026, Humana will launch a new gold card program that waives prior authorization requirements for certain items and services for providers with a record of submitting coverage requests that meet medical criteria and specific outcomes metrics for members.
The company will begin to publicly report its prior authorization metrics, including requests approved, denied, and approved after appeal, along with average time between submission and decision.
In June, nearly 50 insurers committed to implementing a standardized submission process for electronic prior auths by 2027 and reducing overall requirements.
